Medical Specialties Commons^™

Perioperative And Acute Care Transesophageal Echocardiography (Toe), Madiha Hashmi

Department of Anaesthesia

In Pakistan perioperative transoesophageal echocardiography (TOE) during cardiac surgery is available in a few centers with reliance on cardiologists and cardiac technicians and its use in noncardiac surgery and intensive care units is very limited. In view of the increasing popularity of TOE based on obvious benefits this review is presented with an aim to evaluate the current indications and potential benefits of using TOE during anesthesia for cardiac and non-cardiac surgery and the intensive care units and compare TOE with pulmonary artery catheter (PAC) and transthoracic echocardiography (TTE) as an hemodynamic monitor in the acute care setting.

Predictors And Outcome Of Tetanus In Newborns In Slum Areas Of Karachi City: A Case Control Study, Arjumand Sohaila, Yasir Shafiq, Shazia Azim, Benazir Baloch, Ali Syed Muhammad Akhtar, Shiyam Sunder Tikmani, Nick Brown

Department of Paediatrics and Child Health

Background: Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.
Methods: We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for …

“Looks Can Be Deceiving”: Adrenal Teratoma Causing Diagnostic Difficulty, Mehwash Nadeem, Muhammad Hammad Ather, M Nasir Sulaiman, Shahid Pervez

Department of Pathology and Laboratory Medicine

Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological …

Rhesus And Kell Phenotyping Of Voluntary Blood Donors: Foundation Of A Donor Data Bank, Farheen Karim, Bushra Moiz, Fahmida Jan Muhammad, Fatima Ausat, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To assess the Rhesus (Rh) and Kell (K) phenotype of voluntary blood donors and lay foundation of a data bank of voluntary blood donors. STUDY DESIGN: Cross-sectional study.
PLACE AND DURATION OF STUDY: Blood Bank, The Aga Khan University Hospital, Karachi, in the year 2014.
METHODOLOGY: Voluntary blood donors were inducted after taking written informed consent. Three -5cc of EDTA anticoagulated blood sample was taken to phenotype red cells for C, c, E, e, and Kell antigens using antisera. [DiaMedSwitzerland].
RESULTS: Hundred blood donors were included in the study. ABO blood groups of the donors were: O …

Gastrointestinal Stromal Tumors: A Clinicopathologic And Risk Stratification Study Of 255 Cases From Pakistan And Review Of Literature, Nasir Ud Din, Zubair Ahmad, Huma Arshad, Romana Idrees, Naila Kayani

Department of Pathology and Laboratory Medicine

Purpose:
To describe the clinicopathological features of gastrointestinal stromal tumors (GIST) diagnosed in our section and to perform risk stratification of our cases by assigning them to specific risk categories and groups for disease progression based on proposals by Fletcher et al and Miettinen and Lasota.
Material and Results:
We retrieved 255 cases of GIST diagnosed between 2003 and 2014. Over 59% were male. The age range was 16 to 83 years with a mean of 51 years. Over 70% occurred between 40 and 70 years of age. Average diameter of tumors was 10 cms. The stomach was the most …

Hiv Prevalence In Blood Donors And Recipients In Pakistan: A Meta-Analysis And Analysis Of Blood-Bank Data, Bushra Moiz, Barkat Ali, Muhammad Hasnain Chatha, Ahmed Raheem, Hasan Abbas Zaheer

Department of Pathology and Laboratory Medicine

Background:
The first instances of HIV-antibody detection in donated blood in Pakistan were reported in 1988. Since then, documentation of HIV in blood donors and of rates of transmission via transfusion has been limited. Previously assumed to have a low prevalence, HIV is an increasing health concern in Pakistan. Since there is no national, centralized blood-banking system, there are no reliable data on which to base estimated risks of transfusion-associated HIV infection. This study was therefore conducted to estimate the prevalence of HIV in blood donors and recipients in Pakistan between 1988 and 2012.
Methods:
Meta-analyses were undertaken of reported …

Mammary-Type Myofibroblastoma Of The Right Thigh: A Case Report And Review Of The Literature, Jamshid Abdul-Ghafar, Nasir Ud Din, Zubair Ahmad, Steven D. Billings

Department of Pathology and Laboratory Medicine

Introduction:
Mammary-type myofibroblastoma of the soft tissue is a very rare, benign, mesenchymal neoplasm with myofibroblastic differentiation. To date, 20 cases of extra-mammary myofibroblastoma have been described in literature. To the best of our knowledge, this is the largest extra-mammary myofibroblastoma described in the literature, and the first case reported in this location.
Case Presentation:
A 50-year-old Pakistani man presented with a long history of a painless, huge lump on his right thigh. His clinical examination showed normal-looking skin and there was no inguinal lymphadenopathy. The mass was excised with a clinical impression of soft tissue sarcoma. Gross examination showed …

Hospital Preparedness In Community Measles Outbreaks-Challenges And Recommendations For Low-Resource Settings, Sadia Shakoor, Fatima Mir, Anita Zaidi, Afia Zafar

Department of Pathology and Laboratory Medicine

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission …

Pulmonary Arteriovascular Malformation: A Rare Cause Of Unexplained Hypoxia And Acute Dyspnoea In Young Patients, Nousheen Iqbal, Karim Abdur Rehman, Javaid Ahmed Khan, Tanveer Ul Haq

Section of Pulmonary & Critical Care

2014 BMJ Publishing Group Ltd.Pulmonary arteriovenous malformations (PAVMs) are anomalous vascular connections between arteries and veins in the lung and comprise of two types, simple and complex. PAVMs are associated with congenital conditions such as hereditary haemorrhagic telengiectasia along with acquired causes. We present a case of a 26-year-old man who presented with dyspnoea, palpitations and decreased oxygen saturation as an initial presentation of PAVM, which was treated successively with embolisation.

Food Choices And Practices During Pregnancy Of Immigrant Women With High-Risk Pregnancies In Canada: A Pilot Study, Gina M A. Higginbottom, Helen Vallianatos, Joan Forgeron, Donna Gibbons, Fabiana Mamede, Rubina Barolia

School of Nursing & Midwifery

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.
Methods: This four-phase study employed a case study design allowing for multiple means of data collection …

A Case Report Of Joubert Syndrome In Adult Presenting With Seizures, Ramla Nayaib Hashmi, Umm Ul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Joubert syndrome (JS) is rare autosomal recessive condition characterized by hypotonia, ataxia, psychomotor delay, and variable occurrence of oculomotor apraxia and neonatal breathing abnormalitie,intellectual disability, and specific mid-hindbrain malformation (“molar tooth sign”, MTS) We reportthe case of Joubert syndrome in a 32 years old female patient presenting with intellectual impairment, breathing abnormal breathing patterns like tachypnea followed by apnea ataxia, and seizures. She was diagnosed on the basis of Magnetic Resonance Imaging (MRI) and clinical features. JoubertSyndrome should be considered in all patients presenting with hypotonia, ataxia, nystagmus, breathing abnormalities and developmental delay. Its neuroimaging hallmarks include molar tooth sign …

Effectiveness Of Stretching Of The Flexor Retinaculum With Ultrasonic Therapy In The Management Of Carpal Tunnel Syndrome, Waqar Ahmed Awan, Muhammad Naveed Babur, Misha Ansari, Maria Liaqat

Pakistan Journal of Neurological Sciences (PJNS)

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. …

The Burden Of Dysphagia And Chest Infection In Acute Ischemic Stroke In A Tertiary Care Hospital Of Islamabad Capital Territory, Rao Suhail, Shahzad Ahmed, Sumaira Nabi, Mansoor Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the …

Diagnostic Issues And Clinical Spectrum Of Childhood Degenerative Brain Diseases, Tipu Sultan, Ashfa Ameer Khan, Muhammad Arshad Khawaja, Zia Ur Rahman, Ahsan Waheed Rathore

Pakistan Journal of Neurological Sciences (PJNS)

To find out the spectrum of clinical presentation and typesof neurodegenerative disorders of childhoodin tertiary care child neurology centre of Pakistan. To find out the role of brain imaging in the diagnosis of degenerative brain disorders in children. Methods: It will bea retrospective, descriptive study conducted at department of paediatric neurology,The Children’s Hospital, Institute of child health, Lahore, Pakistanfrom January 1st,2004 to December 31,2013 (10 years). A total of 22,737 patients were admitted in the Paediatric Neurology department in the above said period. Out of them 366 children fulfilled the inclusion criteria. History, clinical examination and relevant investigations were evaluated …

Stiff Person Syndrome: A Diagnostic And Management Challenge, Zoya Sajjad, Anam Abrar, Zafar Ullah, Aasim Rehman, Wasim Tariq, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Stiff person syndrome (SPS) is a rare neurological disorder characterized by progressive muscle stiffness and rigidity, mostly involving axial muscles, resulting in functional disability. It is associated with elevated anti- Glutamic acid decarboxylase (GAD) antibody levels. Electromyography findings are often diagnostic. We present a case of a 48 years old male, who presented with progressive stiffness and rigidity of axial muscles and limbs. His EMG was consistent with SPS. Anti GAD antibodies were markedly elevated. He was treated with rituximab and has improved significantly. SPS is a difficult diagnosis, usually under diagnosed due to lack of awareness among medical community. …

Gender Based Differences In Diabetic Peripheral Neuropathy, Athar Javed, Ahmad Furqan, Mohsin Zaheer, Naeem Kasuri

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic peripheral neuropathy (DPN) is one of the common complications of diabetes mellitus. Aim: To find out gender based differences in frequency of DM, age at diagnosis of DM and subsequent onset of DPN, duration of DM and DPN and electrophysiological patterns. Methodology: On the basis of non-probability purposive sampling, a cross sectional study was conducted at Neurology department, Mayo Hospital, Lahore. Patients fulfilling the ADA criteria for DM, and DPN were included in the study. Data was analyzed using SPSS 16 version. Results: A total of 125 patients were included in the study with 57/125 (45.6%) males and 68/125 …

Comparison Between Greulich-Pyle And Girdany-Golden Methods For Estimating Skeletal Age Of Children In Pakistan, Muhammad Awais, Naila Nadeem, Yousuf Husen, Abdul Rehman, Madiha Beg, Yasir Jamil Khattak

Department of Radiology

Objective: To compare Greulich-Pyle (GP) and Girdany-Golden (GG) methods for estimation of Skeletal Age (SA) in children referred to a tertiary care hospital in Karachi, Pakistan.STUDY Design: Cross-sectional study.PLACE AND DURATION OF STUDY: Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July 2010 to June 2012.METHODOLOGY: Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included. Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 years experience, who were blinded to the actual Chronologic Age (CA) of children.Results: A total of …

Interventions To Promote Adherence To Antiretroviral Therapy In Africa: A Network Meta-Analysis, Edward J. Mills, Richard Lester, Kristian Thorlund, Maria Lorenzi, Katherine Muldoon, Steve Kanters, Sebastian Linnemayr, Robert Gross, Yvette Calderon, K Rivet Amico, Harsha Thirumurthy, Cynthia Pearson, Robert H. Remien, Lawrence Mbuagbaw, Lehana Thabane, Michael Chung, Ira B. Wilson, Albert Liu, Olalekan A. Uthman, Jane Simoni, David Bangsberg, Sanni Yaya, Till Bärnighausen, Nathan Ford, Jean B. Nachega

Internal Medicine, East Africa

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.

Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Community Health Sciences

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Stroke Rehabilitation In Pakistan: What We Know And What We Need To Do?, Farooq Azam Rathore, Akhtar Waheed

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of adult neurological disability all around the globe. There have been some remarkable improvements in the acute management of stroke. These include the use of thrombolysis, development of radiological investigations including computerized tomographic scan and magnetic resonance imaging and establishment of acute stroke units. There have been some promising advances the field of stroke rehabilitation as well in the last three decades.

Prof. Akhtar Ahmed – A Memoir Of Love, Respect, Admiration, And..., Ismail A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

Prof. Akhtar Ahmed – a majzoob, how can it be. What an unusual analogy! I was kind of surprised when I heard this from one of my revered teachers Prof. Iftekhar Ahmed who happen to be one of the students of Prof. Akhtar Ahmed like me. However, when he explained this analogy it made complete sense. He explained that a majzoob throws stones on the salik and treats the salik harshly until he is confident that the salik can go through and endure the hardships on the path. Once satisfied, the majzoob opens up for the salik and the knowledge …

Pattern And Outcome Of Epilepsy At Department Of Neurology At Cmc Teaching Hospital Larkana, Alam Ibrahim Siddiqui, Badaruddin Junejo, Lal Chander Dhingra, Anila Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is third most common chronic neurological disease. Mortality is 2-3% more common in epilepsy patients than in general population. World wide survey have shown that epilepsy responds to treatment in about 70 % of epileptic patients and three fourth of the affected people do not get the treatment they need. So objective of our study was to know the outcome and pattern of epilepsy at Department of Neurology CMC teaching hospital Larkana ,so that in next step we could know which factors could reduce the morbitity and mortality due to epilepsy hence could prevent complications due to epilepsy. Total …

Radiological Findings In Peri-Partum Neurological Emergencies: Experience From A Tertiary Care Hospital, Pari Gul, Bushra Rehan, Saleha Anwar, Muhammad Usman Aziz

Pakistan Journal of Neurological Sciences (PJNS)

Acute neurological diseases requiring hospitalization are unusual in young women. Some of these diseases are unique to pregnancy and the post-partum period including pre-ecclampsia. Others such as cerebral venous thrombosis, ischemic stroke, intracranial hemorrhage, etc. are indirectly related to pregnancy and seen less frequently. To explore the causes of neurological emergencies in this specific patient population, we performed a radiological audit of young women in pregnancy and postpartum period presenting with neurological emergencies. Material and methods: This was a retrospective study carried in the Department of Radiology, Liaquat National Hospital over one year from January 2013 till January 2014, after …

Frequency Of Peripheral Neuropathy In Newly Diagnosed Patients Of Diabetes Mellitus Iion Clinical And Electrophysiological Basis, Muslim Ali Lakhiar, Naila Naeem Shahbaz, Abdul Hafeez Bughio, Jai Prakash

Pakistan Journal of Neurological Sciences (PJNS)

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to …

Endovascular Treatment Of Spontaneous Indirect High Flow Carotid Cavernous Fistula With A Covered Stent., Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The treatment of symptomatic carotid-cavernous fistulas [CCF] has been historically treated in the developed world through the endovascular route. We report our first case of using a covered stent in a patient with spontaneous CCF. Method: Single patient with spontaneous indirect high flow CCF treated with a covered stent. We present retrospective analysis of technical success, initial and 6-month follow-up angiography and clinical outcome. Result: The stent was successfully navigated and deployed covering the CCF orifice. Immediate post stent deployment angiography showed marked reduction in flow and complete occlusion at 6-months. Clinically, patient showed near-complete recovery at 6 months. Conclusion: …

A Clinical Approach To Disorders Of Speech, Apoorva Pauranik

Pakistan Journal of Neurological Sciences (PJNS)

Disorders of speech and communication, including Aphasia (mainly post stroke) are a major community health burden in terms of DALY (Disability Adjusted Life Years). Unfortunately they are relatively neglected with huge treatment gap. Traditionally aphasia related lesion sites have been grouped with reference to Rolandic & Sylvian fissures. However the theoretical models of language and speech organization in brain have undergone major conceptual shifts due to advances in cognitive neuropsychology, linguistics and functional neuro-imaging. Much more widely distributed overlapping neural networks are understood to be actively involved in various communication activities. The notion of speech centers or areas is somewhat …

First International Neuro Rehabilitation & 3rd National Rehabilitation Conference (31st October To 2nd November, 2014), Naveed Babur

Pakistan Journal of Neurological Sciences (PJNS)

The First International Neuro Rehabilitation & 3rd National Rehabilitation Conference was held at Isra Institute of Rehabilitation Sciences, Islamabad Campus Capital City of Pakistan from 31stOct to 2nd Nov, 2014.

Brief Report On 14th International Neurology Update & 7th National Stroke Conference, Muhammad Malik

Pakistan Journal of Neurological Sciences (PJNS)

Learning is an enduring burden for neurologists aiming to maintain a high standard of clinical practice and education. Keeping up to date with new developments in medicine is a real challenge. But it's a challenge all neurologists must take if they are to do justice to their patients and aim for superior clinical expertise. The colossal burden of neurological disorders in Pakistan often overwhelms neurologists and trainees leaving them little time for professional self development.

Malrotation After Reamed Intramedullary Nailing With And Without A Fracture Table For Closed Fractures Of The Femoral Shaft, Rizwan Haroon Rashid, Akbar Jaleel Zubairi, Masood Umer

Department of Surgery Docs

Abstract Introduction: To observe the effect of the choice of surgical table on the incidence of malrotation. Methods: The randomised trial was conducted from July 2012 to January 2013 at the Aga Khan University Hospital, Karachi, during which 74 patients were inducted. Randomisation was done via random allocation software version 1.0.0 and sealed envelopes were used to guide the choice of table. Malrotation was assessed by the operating surgeon using the lesser trochanteric shape signunder intra-operative fluoroscopy. SPSS 19 was used for statistical analysis. Results: The 74 patients in the study were divided into two groups of 37(50%) each using …

Dynamic Hip Screw Fixation For Inter-Trochanteric Fractures: Determinants Of Outcomes, Adil Aijaz Shah, Santosh Kumar, Abdull Rehman

Department of Surgery Docs

bstract

OBJECTIVE:

To evaluate factors associated with revision of dynamic hip screw implant in patients undergoing the procedure for the fixation of intertrochanteric fractures.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone dynamic hip screw fixation surgery between 2008 and 2012. Medical records and data for all patients were obtained from the medical records office. For all patients, the record files were systematically reviewed using a structured, pre-defined data extraction sheet. SPSS 20 was used statistical analysis.

RESULTS:

Out of 317 patients who had undergone the procedure, …